Measurement of Breathlessness in Clinical Trials in Patients with Chronic Heart Failure: The Need for a Standardized Approach: A Systematic Review

AIMS: Chronic breathlessness is a major symptom for patients with compensated chronic heart failure (CHF) and its impact is different to the breathlessness resulting from pulmonary oedema. This systematic review aims to establish which tools have been used for research into the subjective severity of breathlessness in patients with compensated CHF and to discuss recommendations for the future. METHODS AND RESULTS: Medline (1950-2008), Embase (1980-2008), Cinahl (1982-2008), and Cochrane databases were searched for clinical studies in patients with compensated CHF including a subjective measure of breathlessness severity as an outcome measure. A total of 322 studies were found of which 41 were retrieved and 26 studies met the review criteria. Few studies had severity of breathlessness as a primary endpoint. Nineteen used a uni-dimensional tool including visual analogue, Borg or Likert scales, either alone, or as a subscale of a quality of life measure. Five used the CHF questionnaire. Two papers used the Baseline Dyspnoea Index-Transitional Dyspnoea Index (BDI-TDI). CONCLUSION: Despite breathlessness being an important and limiting problem for patients with CHF, we found no consensus on which tool should be used for breathlessness severity, little methodological research to develop such a tool, and a lack of focus on breathlessness as a symptom. A consistent approach to studying breathlessness in patients with CHF is needed in order to make headway in managing this key patient priority.